Get happier, lose weight, be fitter–the efficacy of apps debated in studies present and future pilots

Do they really work to change behavior? Studies for the past seven or so years have debated efficacy; a quick search online will show you a wealth of articles with findings on both sides. We know healthcare-related (consumer behavior and professional apps) are growing like weeds after rain– over 320,000 mobile, wearable, and IoT health apps were available for use in 2017, with 200 added daily (Research2Guidance, IQVIA estimates). But qualitatively, the jury is out.

Three studies published in the last two months come somewhere in the middle.

Obesity and weight loss: A telemedicine-based 12 week study from California State University found that the combination of a secure mobile phone-based platform for data tracking and video conferencing with the research team, plus meeting with the medical doctor once per month, and weekly with a registered dietitian worked to clinical standards, ≥5% of initial body weight loss over six months, for 69 percent of the telemedicine participants (n=13) versus 8 percent in the control group (n=12). Note the substantial hands-on human support each of the 13 participants received. Journal of Telemedicine and Telecare, Clinical Innovation & Technology

Activity monitoring not effective unless users set goals: A 400-person study performed by researchers from the Oregon Health & Science University (OHSU) School of Medicine and their Knight Cardiovascular Institute found that when people used such monitors and apps without a specific goal in mind, their physical activity declined and their heart health did not improve, even if 57 percent thought it did. The subjects, primarily office workers at one site, wore a Basis Peak band for about five months. To gauge heart health, the researchers also tracked multiple indicators of cardiac risk: body mass index, cholesterol, blood pressure and HbA1C. Cardiac risk factors did not change. However, the corresponding author, Luke Burchill MD PhD, told EurekAlert (AAAS) that when paired with specific goals, the trackers could be powerful tools for increasing physical activity. The original study published in the British Journal of Sports Medicine doesn’t go quite that far. 

But it’s great for your morale, especially if you pay for it: A Brigham Young University study published in JMIR MHealth and UHealth (August) confirmed that physical activity app usage in the past 6 months resulted in a change in respondents attitudes, beliefs, perceptions, and motivation. This study’s purpose was to track engagement factors such as likeability, ease of engagement, push prompts, and surprisingly, price–that higher-priced apps had greater potential for behavior change. Possible reasons were that the apps provide additional features or have higher quality programming and functionality. (And user investment?)

One growing area for apps is mental health, where the metrics are solidly behavioral and the condition is chronic. The UK’s National Institute for Health and Care Excellence (NICE) has moved forward in favor of piloting them with NHS England. The latest is one from Germany, Deprexis, that uses texts, emails, questionnaires, and cognitive behavioral therapy to give feedback to users. It also has tools to relax users through audio and visual programs. NICE recommends therapist guidance for the trial. According to Digital Health News, NICE is recommending it should be trialed for up to two years in at least two of the specialist services that were set up to improve access to psychological therapies. Again, cost is a factor in rolling out but others are access to care and freeing up therapist time. The organization also plans to review up to 14 digital programs to treat anxiety and depression over the next three years.

Hat tip to Toni Bunting for much of the above

For further reference: The 2017 R2G mHealth App Developer Economics 2017 study has been released and is available for free download here. The 2017 study surveyed 2,400 mHealth developers and practitioners. (Disclosure: TTA was a media sponsor for the study.)

A fistful of topical events

The London Health Technology Forum has just announced the details of its Christmas evening meeting on 13th December. Star turn will be the seasonally-appropriate Andrew Nowell, CEO of Pitpatpet who has a brilliant story to tell of how an activity tracker can unlock so many revenue sources. Attendees will also unlock mince pies, courtesy of longstanding host Baker Botts, and a roundup of key digital health changes in 2017 from this editor.

NICE Health App Briefings: NICE has finally published the end result of its review of three health apps on their Guidance & Advice list. Given that digital health is so much faster moving than pharma, it is disappointing that these apps appear to be being judged to a very high level of evidence requirement.

For example Sleepio, whose evidence for  effectiveness “is based on 5 well-designed and well-reported randomised controlled trials and 1 large prospective unpublished audit” is still judged, in terms of clinical effectiveness, as “has potential to have a positive impact for adults with poor sleep compared with standard care. There is good quality evidence that Sleepio improves sleep but the effect size varies between studies, and none of the studies compared Sleepio with face-to-face cognitive behavioural therapy for insomnia (CBT‑I).”

This editor is unaware of any other app that has five good RCTs under its belt so (more…)

A few short topical items: NHS Digital, DHACA, IET, more

Rob Shaw, NHS Digital’s Deputy CEO, gave a welcome talk at EHI Live on Tuesday encouraging the NHS organisations to become “intelligent” customers. To quote “We have got to make it easier for suppliers to sell into health and social care”. Let’s hope that the message is received and acted on! Until it is, the Kent Surrey and Sussex AHSN is offering help to SMEs to make that first sales – how to book, and to get more details on the event on 23rd November go here.

DHACA’s Digital Health Safety event, in partnership with Digital Health.London on 7th November is proving extremely popular, to the point where it may be oversubscribed soon, so if you want a seat for this really important event for all digital health developers and suppliers, book now.

The IET is running a TechStyle event on the evening of 22 November entitled the world of wearables aimed at people “between 14 and 114”. For today only (1 November) they are offering a special “2 for 1” deal making the already tiny cost essentially insignificant. Book here.  Hat tip to Prof Mike Short.

Prof Short has also highlighted a recent report from Agilysis looking at the role digital technology can play in delivering the vital step change our nation’s care services need. It concluded that: 

  • Leading digital professionals say lack of digital skills biggest risk to transforming care services fit for the 21st century;
  • Lack of knowledge of digital tools is largely responsible for delays in embracing new ways of working;
  • Believe digital technology could cut costs associated with social care delivery and therefore address the number one issue affecting UK social care today;
  • Digital technology can help local authorities manage both demand (improved customer satisfaction) and supply (improves multi-agency working).

There’s a great (more…)

Tender Alerts: Wigan, Salford, NICE (Manchester), Kirklees

Susanne Woodman, our Eye on Tenders, has four for your consideration, three of which are high value:

  • Wigan Council: “Delivery of Support at Home and Mobile Response Service”. Wigan is seeking TECS to support Borough residents in home-based independent living and in Managed Accommodation developments. The objective is to reduce the local burden of unnecessary hospital admissions, on emergency services, and to reassure families and carers about the person’s wellbeing. The contract is for 60 months and is valued at £2,375,000. Closing is 27 October at 10:15am. More information on TED.
  • Salford Royal NHS Foundation Trust: “Provision of a Digital Control Centre”. Salford Royal will be the test bed for this Control Centre to potentially scale to the rest of the NHS. The Control Centre will use the latest advances in “data analytics and digital health to achieve a world-leading organisation which has operational excellence, the best quality healthcare and patient experience across the entire organization which also includes social care.” The five-year agreement starts August 2018 and is budgeted at £2.0m – £3.0m. More information on Gov.UK.
  • National Institute for Health and Care Excellence (NICE) in Manchester: This is for the NICE External Assessment Centre Framework, to provide a range of health technology assessment services to support its technology evaluation programmes and related activities. It is in four lots: secondary data analysis, primary data analysis, technical and regulatory support, decision support. The contract is for 33 months from award and total value is in the range of £1-6m. Deadline is 20 November at 5pm. More information on TED
  • And a reminder that NHS Greater Huddersfield & North Kirklees’ tender deadline is 20 October.  This tender is open early engagement for the provision of a technology-assisted, rapid access service offering an alternative to hospital-based A&E services. Market test site is in Kirklees for residents of a care home. Requirements are:
    • A 24/7 clinical teleconsultation service delivered via secure video link into residential/ nursing homes, that is utilized instead of patients having to be taken to the local A&E department.
    • A service that provides clinical consultation not a logarithm based approach like 111.
    • A fully managed technical service utilizing bespoke laptops with HD cameras and with 4G SIM or broadband.
    • Deadline is 5pm on Friday 20 OctoberMore information on Gov.UK.

Tender Alert: NHS England–IAPT, Arden & GEM, Yorkshire and The Humber

Susanne Woodman, our Eye on Tenders, has three that cover a major initiative of NHS England, plus two regional telecare projects.

  • NHS England–IAPT (Improving Access to Psychological Therapies). NHS Shared Business Services is procuring ‘Digital Therapies for IAPT Assessment: Project Management Organisation’. The aim of the programme is to find good quality, evidence-based digital therapy packages for use in IAPT services. Up to 14 digital therapy products will be assessed for IAPT by 2020. This will help expand provision of psychological therapies, as well as improving access to digital services, both goals set out in the Five Year Forward View for Mental Health. Clarification questions are due by Wednesday 13 September at 10am. Bid deadline is Monday 18 September at noon. More information and contact here on Gov.UK Contracts Finder. Additional programme information on NICE and IAPT here.
  • Arden & Greater East Midlands: Bravo reference Project 851 is an Innovation and Technology Tariff. There are three parts (2-4): the closest related to health tech is #4, web-based applications for the self-management of COPD. Deadline is 2 October 2017 at 5pm. More information and application links on the Arden-GEM website here.
  • Yorkshire and The Humber: Kirklees Council is seeking a provider of assistive technology and telecare solutions aimed at supporting vulnerable people to live safely and independently in their own home. This also includes support for existing and future social care applications, lone workers, and building security. Value of the contract is £210,000. Deadline is 2 October 2017. There’s not a lot of information on the Gov.UK page and it directs questions to the Kirklees coordinator.

Some London events (to 5 July) and an opportunity to monetise your expertise

To respond to a recent contract Our Mobile Health needs to expand its pool of paid expert app reviewers. Applicants should be proficient health app users, professionally qualified, articulate and able to assess academic papers that justify app effectiveness.  Reviews are done remotely (though reviewers must use the English version of apps) and offer an opportunity for reviewers to position themselves as digital health pioneers. Apply here.

Also, if you’re free in London, here are some events you may wish to consider:

Midsummer’s DHACA Day is at the Digital Catapult Centre, Euston Road, London on  21st June. It is aimed very much at digital health developers, with presentations on IP, new business opportunities, the new medical devices and data protection legislation and much more. DHACA membership remains free; entry to the event, which starts at 10 am for 10.30 am, is just the cost of lunch. Book here.

NICE is launching a new evidence tool for “medtech product developers” on 3rd July at the Royal Society of Obstetricians and Gynaecologists, 27 Sussex Place, London. Attendance is free though expect it to sell out soon! Book here.

The next Health Technology Forum meeting near Bank tube in London is on 5th July at 6.15 pm for 6.30 pm, starting with Giovanna Forte’s epic story of how to sell to the NHS – it’s really not to be missed! There’s also an important digital health dimension as she is looking for a partner to develop her innovation into an integrated service. This is followed by a talk on using digital health to provide acute paediatric care remotely. It’s free to attend though, if you book here, do please come along as otherwise it messes up our host Baker Botts’ kind and generous hospitality arrangements.

(Disclosure: this editor has an involvement in the majority of the above.)

 

Accelerated Access Review published – well worth a read

The Accelerated Access Review is published today. Readers with long memories will recall that it kicked off in the Spring of 2015 aimed at accelerating the uptake of innovation in to the NHS. It had three technical streams – pharma, medtech & digital health, plus a patient stream. This editor, as Managing Director of DHACA, was the digital health champion.

DHACA members were heavily engaged in the consultation, so it is gratifying to see that all DHACA recommendations were accepted. Most important were recommendations that:

  • NICE broaden its reach to include more medtech & digital health recommendations, and consider other means of funding;
  • there be closer alignment of regulatory and NICE data requirements and processes (currently, there can be duplication);
  • a strategic commercial unit is established in the NHS;
  • a small amount of funding is offered to support the commercialisation of disruptive innovative technologies that significantly change care pathways;
  • products not referred to NICE should be assessed only once by NHSE;
  • the route for digital products should build on the “Paperless 2020” simplified app assessment process;
  • the Crown Commercial Service, in partnership with NHS Digital, NHS England, the Department of Health and other system and technology partners, should consider how best to develop an accessible, simple and swift competitive process for procuring digital products from SMEs;
  • NHS England, working with NHS Digital, should develop a generic framework for app prescription.

When implemented, these and all the other recommendations in the report will go a long way to (more…)

The Accelerated Access Review – a personal journey

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/02/AAR-logo.jpg” thumb_width=”200″ /]The Accelerated Access Review (AAR) aims to speed up access by NHS patients to innovative medicines, medtech and diagnostics, and digital health. Of these, digital health is the newest, and because it enables care to be delivered in a far more efficient and patient-centric way, offers great hope for the future of improved patient outcomes and controlled costs.

As someone outside government who was drawn into the digital health stream of the AAR, this blog aims to capture key learnings from the experience.

Challenges

The initial list of obstacles to innovation in the NHS was depressingly long, until carefully differentiated. Top of the pile were items like the NHS’s asymmetric attitude to risk – successful innovations are forgotten, unsuccessful innovations are a life sentence for those involved – which are soluble only by those at the very top.

Then there were the surmountable challenges – for example the fear, uncertainty and doubt over digital health regulation was overcome by (more…)

Three of the best – digital health events at the Royal Society of Medicine for 2016

The Royal Society of Medicine has two unbeatable benefits to offer conference attendees: virtually every world expert is keen to present there and, because it is a medical education charity, charges are heavily subsidised. As a result you get the most bang for your buck of any independent digital health event, anywhere!

And just now the offer is even more attractive as if you book for all three in the next 14 days (ie by 12th February) the RSM will give you a 10% discount on all three!

On February 25th, the RSM is holding their first 2016 conference: Recent developments in digital health. This is the fourth time they have run this popular event which aims to update attendees about particularly important new digital heath advances. For me the highlight will be Chris Elliott of Leman Micro who plans to demonstrate working smartphones that can measure all the key vital signs apart from weight without any peripheral – that includes systolic & diastolic blood pressure, as well as one-lead ECG, pulse, respiration rate and temperature. When these devices are widely available, they will dramatically affect health care delivery worldwide – particularly self-care – dramatically. See it first at the RSM!

I’d also highlight speakers such as Beverley Bryant, Director of Digital Technology NHS England, Mustafa Suleyman, Head of Applied Artificial Intelligence at Google DeepMind (who’ll hopefully tell us a bit about introducing deep learning in to Babylon), Prof Tony Young, National Clinical Director for Innovation, NHS England and Dr Ameet Bakhai, Royal Free London NHS Foundation Trust. It’s going to be a brilliant day!

Book here.

On April 7th the RSM is holding Medical apps: mainstreaming innovation, also in its fourth year. Last year the election caused last minute cancellations by both NICE & the MHRA, who are making up for that with two high-level presentations. Among a panoply of other excellent speakers, I’m personally looking forward especially to (more…)

Apps and wearables – developments over the summer

Trying at least temporarily to distract this editor’s attention from his recent unfortunate experience with Jawbone technology, here are some interesting app and wearables snippets received over the summer.

We begin with news of the first CE certified mole checking app, SkinVision which rates moles using a simple traffic light system (using a red, orange or green risk rating). The app lets users store photos in multiple folders so they can track different moles over time. It aims to detect changing moles (color, size, symmetry etc.) that are a clear sign that something is wrong and that the person should visit a doctor immediately.

This contrasts with the findings of a paper published in June examining 46 insulin calculator apps, 45 of which were found to contain material problems, resulting in the conclusion that :”The majority of insulin dose calculator apps provide no protection against, and may actively contribute to, incorrect or inappropriate dose recommendations that put current users at risk of both catastrophic overdose and more subtle harms resulting from suboptimal glucose control.”, which to say the least of matters is worrying. (more…)

Resources dear boy, resources – useful stuff TTA has been sent recently

During this editor’s brief holiday, the interesting reports really piled up, so here is a selection of what look to be the best, including a few that never got blogged previously:

G3ICT & AT&T have published an excellent new report entitled ‘The Internet of things: new promises for persons with disabilities

The European Parliament has produced an extremely useful compendium of articles and statistics on the silver economy: well worth reading (or at least bookmarking for writing that next EIP AHA project proposal).

If like me, use of the ‘Euro’ prefix always brings to mind the Eurosausage episode of Yes Minister, prepare to be pleasantly surprised by this new online database of digital services for carers of older people jointly produced by Eurocarers and the EC’s Joint Research Centre, and hosted by Eurocarers. This offers access to 78 good practices of digital services for older care at home.

Ofcom’s 2015 Communications Market Report is essential reading for anyone working in (more…)

RSM’s Medical Apps one-day conference 9th April – last call

The next RSM event, entitled “Mainstreaming medical apps; reducing NHS costs; improving patient outcomes” is on 9th April, where there are still a few spaces left. This one-day conference will build on the last two years’ sell-out one-day conferences on medical apps at the RSM.

This year as medical apps are coming of age, the focus is on the critical aspects of mainstreaming them, in particular the various UK and EU regulatory issues that need managing in order to enable apps to be recommended or prescribed with confidence by clinicians. This will also include examples of ground- breaking medical apps as well as the use of electronic games to promote health and wellbeing.

Speakers on the regulatory side include, from the UK Professor Gillian Leng, Deputy Chief Executive of NICE, and Jo Hagan-Brown & Dr Neil McGuire from the MHRA, and from the European Commission Pēteris Zilgalvis, Head of Unit for Health and Well-being. Julian Hitchcock from lawyers Lawford Davies Denoon will give another of his excellent talks summarising the regulatory position from a user’s point of view, Dr Richard Brady will update us on bad apps and Julie Bretland will describe progress on the National Information Board’s work on how best to evaluate medical apps.

From the patient perspective, Alex Wyke will be talking about developing guidelines for good practice in health apps and Dr Tom Lewis from Warwick (in place of Prof Jeremy Wyatt now sadly unable to attend) will be talking about how best to evidence benefits from apps.

Describing some novel apps will be Professor Ray Meddis, on how to make an iPhone a hearing aid, Professor Susan Michie from UCL on gamification of smoking cessation, Ileana Welte from big White Wall on why mental health is such fertile ground for apps, and Ian Hay describing the challenges of using Android apps to deliver artificial pancreas-like functionality for the GSMA Brussels to Barcelona bike ride.

Should be a great day, and at the RSM’s rates, a tiny fraction of the cost of a commercially-run event!

Book here

Supplier offer

For £50/table, the RSM is also offering SMEs the opportunity to demonstrate their medical apps to the professional audience during refreshment breaks and at lunch (for more information on this offer contact Charlotte on 0207 290 3942). There are just four tables left now.

2015: a few predictions (UK-biased)

As intimated in our review of last year’s predictions, we feel little need to change course significantly, however some are now done & dusted, whereas others have a way to go. The latter include a concern about doctors, especially those in hospitals, continuing to use high-risk uncertified apps where the chance of injury or death of a patient is high if there is an error in them. Uncertified dosage calculators are considered particularly concerning.

Of necessity this is an area where clinicians are unwilling to be quoted, and meetings impose Chatham House rules. Suffice to say therefore that the point has now been well taken, and the MHRA are well aware of general concerns. Our first prediction therefore is that:

One or more Royal College/College will advise or instruct its members only to use CE-certified or otherwise risk-assessed medical apps.

The challenge here of course is that a restriction to CE-certified apps-only would be a disaster as many, if not most, apps used by clinicians do not meet the definition of a Medical Device and so could not justifiably be CE-certified. And apps are now a major source of efficiencies in hospitals – (more…)

Looking back over Telehealth & Telecare Aware’s predictions for 2014

Looking back over our predictions made on 31st December last year, it’s hard to quibble with any, and worth hanging on to those that didn’t come good this year.

Our first was

Security and data privacy issues will become a serious mHealth issue in 2014; developers failing to take great care over security and privacy issues will risk very adverse publicity and worse.

Job done: that certainly proved correct, with many being exposed as either selling or potentially selling private information. Clinicians were not immune from privacy invasion eitherHere is a US summary of the issues. Attention was drawn to an EU Article 29 data protection opinion (actually published in 2013) that sought to clarify the legal framework applicable to the processing of personal data in the development, distribution and usage of apps on smart devices, and the obligations to take adequate security measures.   Many apps got hacked too, including FDA-approved ones. There were also items, such as this one, demonstrating how complex the law is in this area in the US. In the EU, the arrival of the Data Protection Regulation in 2015 (now some say 2016) will undoubtedly improve data privacy significantly, though the failure to treat data used for health purposes differently from (more…)

Urgent NICE consultation: a great opportunity (UK)

This is a plea for any reader interested in the future success of medical apps in the UK to take a few minutes over Christmas to respond to a consultation request from the National Institute for Health & Care Excellence (NICE), which this editor has just been made aware of. The triennial consultation on the role of NICE opened in early December and closes on 2nd January – a very short time-frame as it covers the Christmas period!

Details are here. There is a form to download so it is not a challenging task to respond.

Many readers will be aware of this editor’s campaign following extensive research, to widen the remit of NICE to include reviewing the efficacy of medical apps. This is so that doctors can confidently recommend and indeed prescribe (NICE approved) medical apps without fear of liability, in the same way that they currently do for drugs. In addition, when discussing treatments with patients, doctors can then compare the efficacy of apps and of drugs for those conditions – such as depression, anxiety and pain relief – where apps can likely do the job better, at lower cost, with no side-effects. At a stroke this would reduce the cost of drugs to the NHS and take the UK to the forefront of the mobile health revolution.

If you can spare the time over Christmas you would give one person a very Happy Christmas; many thanks in anticipation.

The NICE way to a long and healthy life

The National Institute for Health & Care Excellence (NICE) has produced truly excellent draft guidance entitled Dementia, disability and frailty in later life – mid-life approaches to prevention.

As pointed out by David Oliver’s Kings Fund blog, which alerted this Editor to the NICE document, what is particularly exciting about these guidelines are “the principles and linking themes behind them, and the fact that, instead of just advising clinicians, the guidelines include direct advice to the government on health and wider social policy”.

Put another way, this document represents a holistic approach to coordinating the principal health drivers for a long and healthy old age: a major step to helping people achieve the vision of looking forward to old age. The table on page 15 of the draft emphasises just how wide (more…)